Integrative Review of Breastfeeding Support and Related Practices in Child Care Centers

ObjectiveTo synthesize the extant research on the support of breastfeeding and breast milk feeding and related practices in child care centers (i.e., daycare centers) in the United States and globally.Data SourcesWe used key terms to search Ovid, CINAHL, and PubMed for articles that met eligibility criteria. When potentially relevant articles were identified in PubMed, we used the cited by and similar articles features to identify additional articles. We also examined the reference lists of reviewed studies.Study SelectionWe included original research articles on breastfeeding or breast milk feeding in child care centers published in 2000 or after and available in English. We reviewed titles and/or abstracts of 1,984 articles and abstracted 37 for full-text review. Of these, 16 studies met eligibility criteria and were included in the review.Data ExtractionWe abstracted data from the 16 articles to facilitate comparison and identification of patterns related to support of breastfeeding/breast milk feeding and related practices in child care centers. These data included year of publication, setting, design/methodology (and methodologic limitations), type of respondent/sampling unit (e.g., directors and staff members of child care centers, mothers), sample size, outcome measures, and pertinent study findings.Data SynthesisWe categorized study findings into three themes: Knowledge, Attitudes, and Experiences of Staff Members in Child Care Centers; Implementation and Adherence to Policies, Practices, and Regulations in Child Care Centers; and Prevalence of Breastfeeding in Child Care Centers. Findings indicated staff members generally had positive attitudes toward breastfeeding but tended to remain neutral regarding encouragement and support of breastfeeding. Training and knowledge about breastfeeding among staff members in child care centers appears limited and focused mainly on the storage and preparation of breast milk; however, staff members indicated the desire to obtain additional education about breastfeeding. Few U.S. child care centers or states have comprehensive, evidence-based policies and regulations to address support for breast milk feeding and breastfeeding. The prevalence of breastfeeding in U.S. child care centers is less than that in other child care settings (home-based child care, etc.), child care centers in other developed countries, and national breastfeeding averages.ConclusionWe found a general lack of policies and practices to support breastfeeding in child care centers, particularly in the United States. The degree to which this policy/practice deficit contributes to suboptimal breastfeeding rates among women who use child care centers requires further study.     

Rural Maternity Care

ObjectiveTo provide an overview of current information on issues in maternity care relevant to rural populations.EvidenceMedline was searched for articles published in English from 1995 to 2012 about rural maternity care. Relevant publications and position papers from appropriate organizations were also reviewed.OutcomesThis information will help obstetrical care providers in rural areas to continue providing quality care for women in their communities.Recommendations1. Women who reside in rural and remote communities in Canada should receive high-quality maternity care as close to home as possible.2. The provision of rural maternity care must be collaborative, woman- and family-centred, culturally sensitive, and respectful.3. Rural maternity care services should be supported through active policies aligned with these recommendations.4. While local access to surgical and anaesthetic services is desirable, there is evidence that good outcomes can be sustained within an integrated perinatal care system without local access to operative delivery. There is evidence that the outcomes are better when women do not have to travel far from their communities. Access to an integrated perinatal care system should be provided for all women.5. The social and emotional needs of rural women must be considered in service planning. Women who are required to leave their communities to give birth should be supported both financially and emotionally.6. Innovative interprofessional models should be implemented as part of the solution for high-quality, collaborative, and integrated care for rural and remote women.7. Registered nurses are essential to the provision of high-quality rural maternity care throughout pregnancy, birth, and the postpartum period. Maternity nursing skills should be recognized as a fundamental part of generalist rural nursing skills.8. Remuneration for maternity care providers should reflect the unique challenges and increased professional responsibility faced by providers in rural settings. Remuneration models should facilitate interprofessional collaboration.9. Practitioners skilled in neonatal resuscitation and newborn care are essential to rural maternity care.10. Training of rural maternity health care providers should include collaborative practice as well as the necessary clinical skills and competencies. Sites must be developed and supported to train midwives, nurses, and physicians and provide them with the skills necessary for rural maternity care. Training in rural and northern settings must be supported.11. Generalist skills in maternity care, surgery, and anaesthesia are valued and should be supported in training programs in family medicine, surgery, and anaesthesia as well as nursing and midwifery.12. All physicians and nurses should be exposed to maternity care in their training, and basic competencies should be met.13. Quality improvement and outcome monitoring should be integral to all maternity care systems.14. Support must be provided for ongoing, collaborative, interprofessional, and locally provided continuing education and patient safety programs.     

Maternity Care for Vietnamese in America

ABSTRACT: Among Vietnamese families receiving maternity care in the United States are people with at least five different social backgrounds and religious beliefs. Maternity care is affected by these, and many traditional cultural beliefs and customs regarding pregnancy and birth.     

Maternity Nurses' Knowledge of Factors Promoting Successful Breastfeeding

An investigator-designed questionnaire was used to survey 53 RNs and LPNs at two urban hospitals concerning knowledge far support of breastfeeding mothers. Maternity nurses demonstrated limited knowledge, especially in drugs, maternal emotions, and neonatal physiology as related to breastfeeding. Level of education affected test scores positively; length of experience affected test scores negatively.     

Breastfeeding Rates and Hospital Breastfeeding Practices in Canada: A National Survey of Women

Background: The Baby‐Friendly Hospital Initiative was launched by the World Health Organization and UNICEF in 1989 to promote, protect, and support breastfeeding worldwide. The objective of this study was to report breastfeeding rates and adherence to the Baby Friendly Hospital Initiative of the World Health Organization and UNICEF in Canada, as reported by participants in the Maternity Experiences Survey of the Canadian Perinatal Surveillance System. Methods: Eligible women (n = 8,244) were identified from a randomly selected sample of infants born 3 months before the May 2006 Canadian Census, and stratified by province or territory. Birth mothers living with their infants at the time of interview were invited to participate in a computer‐assisted telephone interview conducted by Statistics Canada on behalf of the Public Health Agency of Canada. Interviews took approximately 45 minutes and were completed when infants were between 5 and 10 months old (between 9 and 14 months in the territories). Completed responses were obtained from 6,421 women (78% response rate). Nineteen of 309 questions concerned early mother‐infant contact and breastfeeding practices. Results: Breastfeeding intention (90.0%) and initiation (90.3%) rates were high, although exclusive breastfeeding rates at 6 months after birth (14.4%) were lower than desirable. The findings suggested a low adherence to several best practices advocated by the Baby‐Friendly Hospital Initiative. Conclusion: Although breastfeeding initiation rates were relatively high in Canada, exclusive breastfeeding duration fell short of globally recommended standards.